Childhood Disabilities & Disorders

Gait abnormalities

What are gait abnormalities?

In the first years of life, a child’s normal gait, or walking cycle, doesn’t resemble that of an adult. A normal one year old has a wide base of support, takes many short steps and tends to walk at a fast pace. The child needs to adjust his body in order to feel more secure and closer to the ground. A child will with a his feet wide apart, hips and knees bent and arms out to the sides to help him keep his balance. Although the child who first learns to walk will fall frequently, this is a normal part of motor learning. It is not until around 3 years old that a child’s walking pattern resembles that of an adult.

There are however a number of gait abnormalities that may become a concern. While many of these disturbances are quite common and tend to correct themselves on their own, some require medical attention. The most common gait abnormalities are: in-toeing, out-toeing, limping and toe walking. These may be the result of alignment issues, positioning habits, weakness or ligament laxity (looseness). There may also be sensory processing or development concerns that need to be addressed.

How are gait abnormalities diagnosed?

The diagnosis of a gait abnormality is made during a physical examination by your child’s physician or during a consultation with a physiotherapist. The professional will carefully observe your child as he/she walks or runs and will complete a prenatal and birth history. Depending on the type of abnormality and its suspected cause, other diagnostic procedures may be done. These include, x-ray, MRI or CT-scan.

What are the most common types of gait abnormalities?

1. In-toeing (The feet turn inward instead of pointing straight when running or walking)
2. Out-toeing (The feet curve outward instead of pointing straight when running or walking)
Severe in-toeing or out-toeing may cause a child to trip or stumble often. However, in most cases, the child is not experiencing any pain. The in-toeing or out-toeing usually does not interfere with the child’s ability to learn to walk but may affect other activities due to a shift in balance.
The most common conditions that cause a child’s foot or feet to curve inward or outward are:
1. Tibial Torsion: The turning of a child’s lower leg bone (tibia) either inward (internal torsion) or outward (external torsion). In the womb, the legs were in a confined position. If this condition exists, it means that the feet didn’t rotate into the turned out position after birth.
2. Femoral Torsion: The turning of a child’s upper leg bone (femur) either inward or outward. It is observed between 2 and 4 years old and is most obvious in 5-6 years old children. Doctors don’t know why this happens but it tends to get better without treatment.

A physiotherapist is able to recommend positions for play and specific activities to help reduce falls and functional limitations. The tendency for turning in or out can be worsened by toddlers sitting on their feet or in the ‘W’ position (buttock on the floor, legs bent at the knees with feet out to the sides. Avoiding these positions can help improve the child’s positioning and alignment.

Is your child limping?

If a child is suddenly limping, walking with an unsteady or uneven walking pattern and favouring 1 leg, it is most likely due to pain caused by a minor injury. Limping can be caused by pain anywhere along the leg. Splinters, blisters or even tired muscles can cause a child to limp but sometimes, limping is the result of a more serious problem. Limping may be present as a result of a sprain, fracture, dislocation, joint infection, arthritis or less commonly, a tumour. The doctor evaluating the child will try to differentiate between painful and non painful limping. Non painful chronic limping may be indicative of a developmental problem and should be evaluated by a specialist.

A physiotherapist would be helpful in guiding the family with exercises, stretching and promotion or avoidance of certain activities in order to improve the limp and prevent further occurrences or injuries.

Is your child walking on his toes?

Most young children toe walk when they’re cruising (walking along furniture when they are first learning to take steps). Most will outgrow this by the age of 2. However, some children walk on their tip toes due to a neurological condition known as spasticity. They have tightness in their calves and are unable to place their feet flat on the ground. Many children diagnosed with Cerebral Palsy use orthotics or braces to control their spasticity and facilitate a more normal walking pattern. Premature babies are more prone to have a condition called diplegia, a form of Cerebral Palsy that involves the bottom ½ of their bodies. Any concern that this may be the case should be discussed with a paediatrician as soon as possible.

There are some children however who have no known diagnosis and walk on their toes. This is called idiopathic toe walking. This is frequently the case in children with language delays and/or developmental disorders. Some of them are able to place their feet flat on the ground but go up on their toes when it’s time to move.

Some reasons may include:

- Discomfort placing their foot flat due to mild stiffness in the calf muscles following months or years of walking this way.
- A sensory processing issue whereby they feel uncomfortable with the feeling of their feet flat on the ground, especially on grass or sand.
- Weakness in a particular muscle group
There is no direct harm to walking on toes however, the calf muscles will become progressively tight and as a result the muscles get weak. Children who walk on their toes ironically have trouble and often delays with jumping activities because their muscles are weak.
It is advised to see a physiotherapist who will show the child and his family appropriate stretches, deep pressure techniques, joint compression and activities to promote normal walking and gross motor function.

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